Abstract
BackgroundAlarm symptoms are used in many cancer referral guidelines. The objectives were to determine the 1-year predictive values (PVs) of colorectal cancer (CRC) alarm symptoms in the general population and to describe the proportion of alarm symptoms reported prior to diagnosis.MethodsA nationwide prospective cohort of 69,060 individuals ≥40 years randomly selected from the Danish population was invited to complete a survey regarding symptoms and healthcare-seeking in 2012. Information on CRC diagnoses in a 12-month follow-up came from the Danish Cancer Registry. PVs and positive and negative likelihood ratios were calculated.ResultsA total of 37,455 individuals participated (response rate 54.2%). Sixty-four individuals were diagnosed with CRC. The single symptom with the highest positive PVs (PPV) and LR+ was rectal bleeding. PPVs were generally higher among individuals aged ≥75 years and highest among those reporting at least one specific alarm symptom that led to a GP contact.ConclusionIn general, the PPVs of CRC alarm symptoms are low and the NPVs high, especially in the youngest age groups. The LR + show a relative association with specific symptoms like rectal bleeding. Future campaigns on early diagnosis of CRC should focus on healthcare-seeking when experiencing rectal bleeding and target older people with the highest incidence.
Highlights
Alarm symptoms are used in many cancer referral guidelines
Individuals aged 75 years or above reporting at least one of the specific alarm symptoms that lead to a general practitioner (GP) contact had a positive PVs (PPV) of 1.9% and LR+ of 3.0 for being diagnosed with colorectal cancer (CRC) and the negative predictive values (NPVs) and LR− for this group was 99.5% and 0.8% respectively (Table 4)
Main findings In this study, we investigated the PPVs, NPVs, LR+ and LR− of specific and non-specific alarm symptoms for CRC in the general population
Summary
Alarm symptoms are used in many cancer referral guidelines. The objectives were to determine the 1-year predictive values (PVs) of colorectal cancer (CRC) alarm symptoms in the general population and to describe the proportion of alarm symptoms reported prior to diagnosis. PPVs were generally higher among individuals aged ≥75 years and highest among those reporting at least one specific alarm symptom that led to a GP contact. Future campaigns on early diagnosis of CRC should focus on healthcare-seeking when experiencing rectal bleeding and target older people with the highest incidence. The. 5-year survival rate ranges from 90% for localised stage CRC to 10% for patients with distant metastases.[2] To promote early diagnosis and improve survival rates, many countries have implemented cancer referral guidelines and fast track endoscopy for patients with alarm symptoms indicative of CRC.[3,4] For CRC, alarm symptoms are specific symptoms such as rectal bleeding or changes in bowel patterns for individuals ≥40 years. For the rest of the cases and in the group aged 75 years and older, symptoms will still have a significant role in the diagnostic process of CRC
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